Case 46 Answer 2

The images show two hypoechoic masses which are well-defined. Multiple
internal echoes make the diagnosis unclear. These could represent cysts or solid
masses. The definition of a simple cyst requires the mass to be anechoic. Any
jury can see from 30 feet that there are internal echoes in these masses.

Repeat ultrasound shows:

It is true that one can make anything anechoic if you turn down the gain
enough. However, the gain can be turned down until the fat is appropriately
hypoechoic. If the fat is anechoic, you've turned it down too far. Turning on
harmonic imaging, as in the second image above, is often helpful to eliminate
artifactual echoes.